Epidemia de Diabetes Mellitus Tipo 2 en Latinoamérica
Palabras clave:
Diabetes Mellitus tipo 2, Latinoamérica, Programación Fetal, Prevención, Epigenética, Type 2 Diabetes Mellitus, Latin America, Fetal programming, Preventive measures, EpigeneticsResumen
Introducción: Los países latinoamericanos presentan un crecimiento acelerado de la prevalencia de DM2 por la asociación de determinados condicionantes. La cabal comprensión de estos condicionantes es fundamental para combatir la epidemia de DM2 en Latinoamérica, entendiendo que un programa eficaz de prevención de esta patología demanda un esfuerzo concertado de todos los actores de la sociedad, y no solo del equipo de salud.
Objetivos: Con el fin de detectar algunos condicionantes que posiblemente están asociados a la epidemia de DM2 en Latinoamérica, se revisaron trabajos incluidos principalmente en la base de datos de PubMed; se incluyeron investigaciones de los últimos cinco años, realizadas en el país y la región o en países receptores de migrantes latinoamericanos.
Resultados: La Diabetes Mellitus tipo 2 (DM2) está asociada al incremento en las tasas de obesidad y sobrepeso, producto de la rápida urbanización experimentada en los últimos años, la cual determina cambios en actividad física y hábitos dietéticos. Además, la programación fetal de hijos de madres mal nutridas durante la gestación, determina una mayor sensibilidad de estos niños con bajo peso al nacer para desarrollar resistencia a la insulina e inflamación de bajo grado, especialmente cuando se ven sometidos a un medio de excesos alimentarios (a menudo de “comida chatarra”) para los cuales no estuvieron programados, lo que les lleva a presentar obesidad abdominal y mayor riesgo de DM2.
Discusión: Los condicionantes de la presencia de DM2 en Latinoamérica se relacionan con un desarrollo socio-económico anormal, pues básicamente responden a la contradicción entre la necesidad de adaptación del feto a una alimentación materna defi ciente o a una insuficiencia placentaria producto de enfermedades como la preclampsia; y en la etapa adulta, el modo de vida urbano lleno de excesos alimentarios, con alto consumo de grasas saturadas, harinas, bebidas endulzadas y sedentarismo, condiciones que determinan resistencia a la insulina y DM2.
Palabras clave: Diabetes Mellitus tipo 2, Latinoamérica, Programación Fetal, Prevención, Epigenética.
AbstractType 2 Diabetes Mellitus Epidemics in Latin America
Introduction: Certain conditioning factors have contributed to the increased prevalence of type 2 diabetes mellitus (DM2). In devising a strategy to control DM2 epidemics in the region, it is of paramount importance to fully understand these conditioning factors, since all actors in society have to cooperate with health teams in preventing this pathology.
Objectives: A PubMed search of original work published mainly in last five years on the subject, was carried out. Investigators were in Colombia, the Region and in Hispanic migratory flow receptor countries as well.
Results: DM2 is closely associated to increased rates of obesity and overweight. A large and quick flow of people moving from rural areas to large cities determine changes in dietary habits and a sedentary life style, with increased caloric intake and decreased energy-expenditure. Fetal programming in malnourished pregnant women results in low birth-weight infants prone to develop insulin resistance and low grade inflammation; this is particularly true when they are raised eating high caloric “junk” food, not suitable to their caloric-saving genes. This unfitted nutrition gives adults with abdominal obesity and increased risk of DM2.
Discussion: Children born to undernourished mothers and/or with placental insuffi ciency due to pre-eclampsia are not adapted to an unexpected hypercaloric environement, when there is an abnormal socio-economic development. Higher intakes of saturated fat, carbohydrate-containing food, and glucose-rich beverages together with a sedentary life style are conditioning factors to the increased prevalence of insulin-resistance and DM2 in Latin America.
Key words: Type 2 Diabetes Mellitus, Latin America, Fetal programming, Preventive measures, Epigenetics
Biografía del autor/a
Patricio López-Jaramillo, Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lulle (FOSCAL) Dirección de Investigaciones, Facultad de Medicina, Universidad de Santander (UDES).
Dirección de Investigaciones, Desarrollo e Innovación Tecnológica, Fundación Oftalmológica de Santander-Clínica Carlos Ardila
Lulle (FOSCAL).
Juan José Rey, Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lulle (FOSCAL)
Dirección de Investigaciones, Desarrollo e Innovación Tecnológica, Fundación Oftalmológica de Santander-Clínica Carlos Ardila
Lulle (FOSCAL). Observatorio de Salud Pública de Santander. Recibido: Abril 15 de 2010. Aceptado: Octubre 21 de 2010.
Yudy A. Rodríguez, Facultad de Medicina, Universidad de Santander (UDES).
José López-López
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